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Provider Engagement Panel PacificSource Community Solutions
2965 NE Conners Ave, Bend OR 97701 Twin Lakes North – 1st Floor
March 11, 2020 from 7:00am-8:00am Virtual Dial-In: Zoom
Join by computer: https://zoom.us/j/630619272 Join by phone only: 1-669-900-6833, code: 630619272#
7:00-7:05 Introductions – Divya Sharma • Approve Consent Agenda
7:05-7:20 QHOC – Alison Little Attachment: QHOC report Feb/Mar 7:20-7:45 2020 QIMs – Andrea Ketelhut Continued from February 7:45-7:55 ECHO Prioritazation – Divya Sharma Attachment: Questionairre
7:55-8:00 Wrap Up – Divya Sharma
Consent Agenda:
• Approval of the draft minutes dated February 12th, 2020 subject to corrections/legal review
• Diabetes/Oral Health Letter Endorsement Written Reports:
MINUTES OF A MEETING OF
THE PROVIDER ENGAGEMENT PANEL OF
CENTRAL OREGON HEALTH COUNCIL
HELD AT PACIFICSOURCE IN TWIN LAKES NORTH
February 12, 2020
A meeting of the Provider Engagement Panel (the “PEP”) of Central Oregon Health
Council, an Oregon public benefit corporation (the “Corporation”), was held at 7:00 a.m. Pacific
Standard Time on February 12, 2020, at PacificSource in the Twin Lakes North room in Bend,
Oregon. Notice of the meeting had been sent to all members of the Panel in accordance with the
Corporation’s bylaws.
Members Present: Divya Sharma, MD, Chair
Gary Allen, DMD (call-in)
Michael Allen, DO
Logan Clausen, MD (call-in)
Matt Clausen, MD (call-in)
Muriel DeLaVergne-Brown, RN, MPH
Keith Ingulli, PsyD
Alison Little, MD
Sharity Ludwig
Jessica Morgan, MD
Laura Pennavaria, MD
Members Absent: Jovanna Casas, PharmD
Robert Ross, MD
Guests Present: Gretchen Horton-Dunbar, PacificSource
Andrea Ketelhut, PacificSource
Donna Mills, Central Oregon Health Council
Bhavesh Rajani, PacificSource
Kelsey Seymour, Central Oregon Health Council
Dr. Sharma served as Chair of the meeting and Ms. Seymour served as Secretary of the meeting. Dr.
Sharma called the meeting to order and announced that a quorum of directors was present and the
meeting, having been duly convened in accordance with the Corporation’s bylaws, was ready to
proceed with business.
WELCOME
Dr. Sharma welcomed all attendees to the meeting. Introductions were made on the phone and around
the room.
2020 QIMS
Ms. Ketelhut reviewed 2019 Quality Incentive Metric (QIM) final performance. She introduced the
new measures included for 2020. The group discussed the adolescent immunizations metric, noting
that giving an HPV vaccination by a child’s 13th birthday could prove challenging. Dr. Logan Clausen
noted that patient’s parents are less resistant if the vaccination series is started young, nearer to age 9,
but that not all insurances cover the vaccine until age 11. Dr. Sharma asked her to identify those
insurance companies that do not cover it before age 11 and bring a list to the Panel. Ms. DeLaVergne-
Brown suggested engaging the Youth Advisory Councils (YACs) from the schools in the discussion.
Dr. Matthew Clausen suggested that HPV vaccinations might be more effectively offered by dentists
because of their direct connection to oral cancer prevention. Dr. Gary Allen and Ms. Ludwig noted
the cost-prohibitive nature of keeping vaccinations onsite at dental clinics, especially in rural areas,
and noted the administrative burden would be immense.
The group agreed to delay the discussion of the last new QIM, Initiation and Engagement for
substance abuse, until the next meeting.
ACTION: Dr. Logan Clausen will bring a list of insurance companies that do not cover HPV
vaccinations for children under age 11.
DIABETES/ORAL HEALTH LETTER OF ENDORSEMENT REQUEST
Ms. Ludwig asked the Panel to review the materials assembled by the Diabetes Clinical workgroup
demonstrating the connection between oral health and diabetes care. Dr. Sharma asked members to
review the materials and prepare for endorsement at the next meeting.
ACTION: Ms. Seymour will send the materials to Panel members for review via email.
WORKFORCE DEVELOPMENT
Ms. Horton-Dunbar explained that CCO 2.0 will require PacificSource Community Solutions (PCS)
to participate in workforce development efforts throughout the region and across areas of specialty.
She noted that PCS’ assessment revealed a high need for Traditional Health Workers, such as Peer
Support Specialists and Community Health Workers. The Panel made suggestions about how PCS
might effectively participate in workforce developments that are already underway.
ACTION: The PEP agreed to invite Ms. Horton-Dunbar back for further discussion about how these
efforts might align with the Regional Health Improvement Plan.
CONSENT AGENDA
Dr. Sharma asked for a motion to approve the consent agenda. Ms. DeLaVergne-Brown motioned,
Dr. Michael Allen seconded. All were in favor, the motion passed unanimously.
ADJOURNMENT
There being no further business to come before the PEP, the meeting was adjourned at 7:08 am
Pacific Standard Time.
Respectfully submitted,
_________________________
Kelsey Seymour, Secretary
Dear Central Oregon Clinic Leadership,
As you are aware, beginning in 2019 “Oral Evaluation for Adults with Diabetes” became a CCO quality incentive metric. At the request of the Central Oregon Health Council Provider Engagement Panel, an informational campaign was developed for the community to raise awareness on the connection of oral health and diabetes.
Advantage Dental from DentaQuest took the lead in creation of campaign materials, as they possessed existing content. Engagement from the Central Oregon Health Council Regional Health Improvement Plan Clinical Diabetes and Oral Health workgroups occurred in the review of the materials to support alignment across disciplines. The workgroups contain members from COIPA, St. Charles, Mosaic, PacificSource, local public health offices, and many others.
Accompanied with this letter you will find an oral health kit and a sample of the materials that have been created. In addition, below is an explanation for each of the developed materials. Our request is that you will share this information with your organization to support dissemination of the materials to diabetic members to raise the awareness and encourage annual dental visits.
Document Name: Intended Audience:
Co-brand: Intended Use: Available Languages:
The Link Between Oral Health And Diabetes (474BEP_Diabetes-Brochure)
Patient Yes – Open space on back middle panel – CCO names and phone numbers can be added
Provide an overview of the connection between diabetes and oral health. Information on “Where to go for care locations” on back panel.
English and Spanish
Mouth Body Connection (475SEP_08022019_AD_BodyOralHealth-11x17Poster-Patient)
Patient CCO logo can replace Advantage Dental logo
Requested by non-dental providers to hang in medical rooms, waiting area, etc.
English and Spanish
Mouth Body Connection – Provider (476SEP_BodyOralHealth-Provider– 8.5 x 11 flyer)
Non-Dental Provider
CCO logo can replace Advantage Dental logo
Informational piece given to non-dental providers to increase oral health awareness regarding the overall impact oral health has on overall health.
English
Mouth Body Connection – Post Card (477IEP_07312019_Diabetes_4x5_Patientv2)
Patient No Card version of 475SEP. English and Spanish
Oral Health Tips for Managing Diabetes - Handout (478IEP_07312019_AD_Diabetes_Handout2.0)
Patient Yes –CCO names and phone numbers can be added at the bottom of the flyer
To provide to diabetes patients to improve knowledge on diabetes and oral health. (Adapted from IHN Diabetes Medical Integration pilot)
English and Spanish
Oral Health Tips for Managing Diabetes – Tips Card (479IEP_08022019_AD_Diabetes_4x5tipscard)
Patient No Card version of the 478IEP to place in oral health toothbrush kits to distribute to diabetes members at medical appointments.
English and Spanish
Materials are ordered through the Central Oregon Health Council by completing the order form at: www.cohealthcouncil.org/oral_helath_diabetes
The Central Oregon Health Council Provider Engagement Panel endorses the materials outlined in this letter. Our membership includes medical, behavioral, and oral health leaders from PacificSource, Advantage Dental, St. Charles, Mosaic Medical, Central Oregon Pediatrics Associates, La Pine Community Health Center, Central Oregon Independent Practice Association, and public health. We hope you’ll join us in our efforts to make a healthier Central Oregon.
____________________________________ Divya Sharma, MD Chair, Provider Engagement Panel
____________________________________ Donna Mills Executive Director, Central Oregon Health Council
OHA contact info: lisa.t.bui@state.or.us 1
OHA Quality and Health Outcomes Committee (QHOC)
January 13, 2020 Webinar or conference line, 1-888-278-0296, code 310477
Meeting Packet
Agenda
QHOC Website
Slides
Clinical Director Workgroup
10:00 a.m. – 12:30 a.m.
Topic Summary of Discussion/Impacted Departments Materials/
Action Items
Welcome/
Introductions/
Updates
Presenter: Holly Jo Hodges, Lisa Bui
Introductions in the room
Update from Lisa: if you did not respond to the email from her sent
11/4/2019 regarding remaining on the QHOC list, then QHOC 2020
meeting series will go to the CCO Innovator Agent.
To save time, Holly Jo referred audience to the agenda packet for
details on the following:
Public Health Update
TC TA Update
HERC Materials
P&T February 2020 Agenda
Pg. 2
Pg. 3-9
Pg. 30-89
Pg. 90-92
Performance
Based
Reward (PBR) &
Prometheus
Overview and purpose: Performance Based Rewards are intended
to provide
Credit for qualified Health Related Services
Goal is to avoid rate slides due to HRS spending
PBR will be built into 2022 rates due, with baseline in 2020
Prometheus is one component of PBR, intention is it will help
bend cost curve by creating better efficiencies
PBR components include:
o Global Medicaid savings drives total available PBR
(statewide pool of funds that can be distributed to CCOs
based on performance)
o HRS spending (rewards CCOs with higher HRS
investment)
o Reward CCO efficiency, as measured by Prometheus
(see below)
o Reward CCOs individually based on their cost growth
target
o Quality (must meet QIMs to qualify for additional
payment)
Presentation and example from the field: Mark Wallace
(Colorado)
Plan to look at 3 PAC’s
Identify PAC’s, and gave reports to RAE
Created some hypothesis to identify root causes, and had clinical
teams create interventions
Presentation
Slides (10-22)
Process Measure
(23-28)
Process Measure
and Scoring*
Process Measure
Action Plan*
OHA contact info: lisa.t.bui@state.or.us 2
Identified C-section rate and came up with a plan
Tool to bring others to the table
Prometheus: (Demonstration of tool provided)
Algorithm that identifies potentially avoidable complications (PAC)
associated with an episode of care
Example provided: Sepsis is considered 100% avoidable
complication of SUD
CCOs must submit a plan for specific episodes, including:
o Identification of episodes and potential savings
o Outreach to providers/members
o Documentation of outcomes/follow up
o OHA selected default episodes, which are asthma,
diabetes and SUD
Data will be provided in Tableau
Rollout of CCO specific data expected in late January
Future Trainings and Meetings
4 meetings with finance and OHA to train clinical and finance
staff
Other user support groups will be held in 2020
CCO Deliverables for Prometheus:
CCO’s will need to provide an action plan in the end of March
about Prometheus uses
Other
OHLC did report with Milliman’s waste calculator to look at
data from Washington on Vitamin D testing and found 47
specific services that were over used
Oregon will run data at State level
Reports to come
Out of Hospital
Birth (OOHB)
Presenters: Dave Inbody
Previously members were disenrolled from the CCO and had to
get prior auth from the OHA. They were then covered by FFS
In 2020 (effective 2/1) members requesting OOHB will no
longer be disenrolled, and there will be a carve-out for their
maternity care instead
Standard PMPM will be provided to CCO for provision of non-
pregnancy related physical health (NEMT, labs etc.); will not
include the maternity extra payment
About 200-300 requests a year to OHA, with about half being
approved
If CCO’s take care of a hospital delivery they get maternity extra
payment
Format may be similar to DHS Kids
Unsure of who takes care of OB consult bill
Suggestion to carve OOHB from Postpartum incentive measure
Memo (29)
OHA contact info: lisa.t.bui@state.or.us 3
Quality and Performance Improvement Session
1:00 p.m. – 3:00 p.m.
QPI
Intro/updates
Presenters: Jenna Harms, Lisa Bui
HSAG is holding a webinar on 2/4/20 from 1-2pm about an
overview of the External Quality Review (EQR) in 2020:
o 5 member focused standards
o Key dates
DCO’s have to have their own PIP’s for fee for service clients
through OHA. o OHA may be asking DCO’s to work together with
CCO’s on oral health PIP’s
n/a
TQS
(Transformation
and Quality
Strategy)
Updates
Presenter: Lisa Bui
General webinar slides and recordings are available on the
website
“Subcomponents” have been removed from naming conventions
Number the projects to make it easier for OHA to follow and
track projects
Be mindful of continuing numbers from year to year as projects
close out
Flyers with all webinar info have been posted to share with
appropriate staff
Refer to Guidance document for naming conventions
Value-based payments (VBP) was removed from TQS
requirements
Second Opinions were removed from TQS requirements
TQS office hours are available for leads to call in with questions
March 16th deliverables are due for existing CCO’s
Scoring
Each component is scored separately, across all projects.
Each project will get a separate score
Projects that address multiple components will have an average
score
OHA would like feedback if written assessment and resources
are useful
Suggestion to help CCO’s connect with other CCO’s who have
similar or unique projects
o This might be added to the resource section of the
written assessment
Closing out Projects/ continuing old ones
Be sure to mark the appropriate place on the template to indicate
that projects have been closed out
Transition from 2019 to 2020 TQS:
o A closing report is not required
o In background rationale provide a high level description
about what informed your decision to close out the
project
o Where you’re at, why you chose a new project
TQS Scoring &
Overview (93)
OHA contact info: lisa.t.bui@state.or.us 4
Continuing project: provide updates on activities/actions from
last year and plans for movement forward (in the community,
etc.)
o A general lookback at the prior year
o CAC feedback if applicable
You can send a project example to OHA by 2/21/20 (up to 3
components) to leads.
Statewide PIP
Update
Presenters: Lisa Bui
Study question for 2020 is: “Among opioid naïve who are
prescribed opioids decrease the number of patients prescribed >7
day opioid supplied.
January 31st deliverable with HSAG email to come.
Worksheet will be provided that summarizes all the work
completed around the topic.
CCO’s are responsible to talk about how they will inform
protocol submitted to HSAG based off of worksheet.
o Steps 1 through 6 are due on 1/31/20
Oregon EQR site has validation tool, PIP submission completion
form instructions, and other information for guidance
No baseline needed for 1/31/20 submission
Other 3 PIP’s
If you want to switch PIPs submit generic PIP form and email,
including why you are switching.
You can email Lisa for pre-consult before switching, or with
questions about filling out the PIP form or if a project warrants a
PIP.
New CCO’s in new regions, who want to submit new PIPs:
o OHA is working with HSD to determine deadlines
and timing
o No news on all deliverables required yet
o Send Lisa an email to remind her to follow up with
Medicaid office
Email Lisa if you need details about how to change PIPs if you
need ideas and timing on how to close out
You may receive a phone call from Lisa if your PIP needs
further review after submitting.
New PIP notifications will be reviewed and if you do not hear
back, everything is ok.
PIPs should be more than operational and lead to quality, or you
could receive a call to clarify project
On the 11 page CCO deliverables document the PIPs where left
out on accident.
Other contact details and mailing list
Innovator agents should be checking to see who should be on
the QHOC list
Separate quality list – “quality” staff should be included already.
Email Lisa with questions
n/a
2020 QPI Session
Planning
New topics of discussion for 2020 (bringing in subject matter experts…learning collaborative, best practices, etc.)
n/a
OHA contact info: lisa.t.bui@state.or.us 5
BHI Integration
SDOH/E
Health Equity
CCO spotlights
Rule changes
Health Related Services
Care plans/ care coordination
MH Parity
HRS and Prometheus
New Measures (Initiation and engagement, SUD ect) * slotted
for next month’s meeting
Adjourn
Everyone is welcome to the meetings. For questions about accessibility or to request an accommodation, please call 971-
304-6236 or write OHA.qualityquestions@dhsoha.state.or.us. Requests should be made at least 48 hours prior to the event.
Documents can be provided upon request in an alternate format for individuals with disabilities or in a language other than
English for people with limited English skills. To request a document in another format or language, please call 971-304-
6236 or write OHA.qualityquestions@dhsoha.state.or.us.
OHA contact info: lisa.t.bui@state.or.us 1
OHA Quality and Health Outcomes Committee (QHOC)
February 10, 2020 Webinar or conference line, 1-888-278-0296, code 310477
Meeting Packet
Agenda
QHOC Website
Slides
Clinical Director Workgroup
10:00 a.m. – 12:30 a.m.
Topic Summary of Discussion/Impacted Departments Materials/
Action Items
Welcome/
Introductions/
Updates
Presenter: Holly Jo Hodges, Lisa Bui
Introductions in the room
To save time, Holly Jo referred audience to the agenda packet
for details on the following:
Public Health Modernization: Funding allocated to local public
health for interventions to address communicable diseases.
o Some CCO’s have developed partnerships to prevent
communicable diseases
Opioid tapering guidelines to be released soon.
The change in how home births are reimbursed has been
delayed. OHA is continuing to consider the impact to the post-
partum QIM by not disenrolling the member. More information
will be provided in March.
Pgs. 3&4
HIT Strategic
Updates
Presenter: Susan Otter, Health Information Technology
Oversight Council (HITOC)
Current state of HIT reform has informed EMR through
Meaningful Use Program, Edie platform adoption, and CCO
Incentives
Five year strategic plan includes:
o Sharing patient information across the care team
o Using data for system improvements
o Patients Accessing their own records
o Supporting Social Determinants of Health
o Value-based payments
o Behavioral Health and HIT
6 Listening Sessions will take place throughout April, and
written comment can be submitted.
o Listening sessions will be held on topics such as oral Health
Integration, CCO listening session, and behavioral health
listening session
o See slides for dates and times of listening sessions.
A retreat will be held in June to look at feedback, and a final
review will happen in December from the Health Policy board.
Trillium and IHN have Community Information Exchanges
(CIE)
Pgs. 11-18
OHA contact info: lisa.t.bui@state.or.us 2
Health Evidence
Review
Commission
(HERC)
Presenter: Cat Livingston and Ariel Smits
Bone marrow transplant for Sickle Cell patients
o If HLA matches, it should be covered; if not, wait for
complication. Will assess financial impact by sending to
actuary, the earliest this would take effect is 10/1/20.
They will also be reviewing beta-thalassemia
Compression Stocking coverage is in a “grey area”
o Currently non-covered; will be adding for non-healing
ulcers, bleeding, cellulitis (ATL)
o Little evidence to support effectiveness
Vitamin D Testing changes
o Private insurers are no longer covering it.
o Removing from diagnostic file, pairing it with specific
lines based on OHLC recommendations
Yoga and acupuncture for PTSD – little evidence to support
coverage
Tens unit all on line 660
Fetal meningomyelocele repair added
Spinal cord stimulator guidelines revised
Yttrium 90 mapping procedure changes
o Pretreating with embolization no longer a covered
practice
o Providers can talk with OHSU for questions
Impella heart pump: covered with stipulations
Out of Hospital Birth: first round of public comments have been
reviewed, and there will be another round of public comments
Multi-sector interventions for improving colorectal cancer
screening will be considered at an April meeting
Topics in development:
MRI for knee
Female genital mutilation repair (currently unfunded)
o Guidelines should emphasize repair only
Spinal injections for diagnostic reasons
Zio patch
Pre-op testing
Acupuncture for cancer patients: indication that is reduces opioid
dependency
Biannual review topics:
o Back lines, chronic pancreatitis, fecal incompetence, FB
in nose and ear, sinusitis, psoriasis, adult FTT,
dysfunction lines, bone grafts, peripheral nerve ablation
Pgs.: 19-40
P&T
Presenter: Roger Citron
(Quick review and reference to slides.)
Antifungal class update – no changes
Anticoagulants – no changes
Rifamycin – non-preferred
Amikacin – non-preferred PA criteria
Class review for Gaucher’s Disease
o miglustat – non-preferred
o taliglucerase preferred
Amifamprdine
Pgs: 41-48
OHA contact info: lisa.t.bui@state.or.us 3
o Amifampridine (Ruzurgi) preferred
Cholic Acid: non preferred
Remove PA for MAT in opioid use disorder products
o Still have QL in place – Sublocade preferred.
o Bunavail – voluntary non-preferred
Antidepressant use in kids – safety edit for younger than FDA
age (GP, new start)
Dupilumab:
o PA for nasal polyposis
Future Meetings:
February P&T Committee will be held on first Thursday of even
numbered months
Kindergarten
Readiness
Learning
Collaborative
Presenters: Dana Hagunani, Sara Kleinschmidt (OHA);
Development of metrics:
Workgroup of community and providers developed measures
and focused on:
o Determining health sectors role
o Defining measures
o Conceptual Framework and identifying gaps
o Measurement Strategy and framework broken down by
populations (children, parents, and special needs)
Centering Family Voices focus groups were conducted by PSU
to get feedback from parents and family stakeholders about
health sectors role.
2 measures were recommended and adopted for 2020
o Well Child 3-6ys old
o Preventative Dental visits 1-5 yrs. and 6-14 yrs.
2 measures are still in development
o Attestation for social and emotional wellness
o Follow up to Developmental Screening
Presentation: Andrea Ketelhut, Theresa Mcintyre (PSCS)
Working with community providers to promote best practices
o Monthly meetings with providers
o Quarterly all provider meetings
o Monthly gap lists
o Assist with EHR Reporting
o Research best practices/host community workshops
Presentation: Courtney Whidden-Rivera, Kali Paine (EOCCO)
Child Wellness Mailing Campaign
o Comprehensive patient education tied to all measures
o Different mailing strategy campaign depending on age
Interactive voice response
o Immunizations and well child visits
o Automated calls
Clinic education and support
o Provider progress reports
o Clinic visits and trainings
o Fliers
o Encourage collaboration
Pgs: 49- 76
OHA contact info: lisa.t.bui@state.or.us 4
Quality and Performance Improvement Session
1:00 p.m. – 3:00 p.m.
QPI
Intro/updates
Presenters: Jenna Harms, Lisa Bui
n/a
TQS
(Transformation
and Quality
Strategy)
Updates
Presenter: Lisa Bui
All TA webinars have been posted
If you would like to have a project reviewed send it by 2/21/20
to Lisa.
TQS office hours are in affect for further questions
Updated health equity examples have been posted
Make sure that the Background and Rationale sections are
thorough
No 2019 final update is due
n/a
CCO
Performance
Improvement
Projects
Presenters: Lisa Bui
Review of PIP topics on slides
PIPs should be rapid cycle projects
They can support QIMs
HSAG reviews PIPS to determine TA that might be needed
based on topics
o PIPs are not validated and scored
Focus studies are “more exploratory” and more time is allowed
to develop interventions and “Plan.”
Read CMS PIP protocol.
Lisa should be emailing forms from previous regions to new
regions.
Q/A:
New CCO PIP deliverables?
Lisa said she received email about deliverables for new
CCO’s and it was forwarded and will be reviewed.
Can you have more than 1 focus study (and for new CCO’s)?
TBD
Updating PIP Notification form with new CCO’s and all focus
areas?
It will be updated and posted.
How to end a PIP?
No closing form. In progress report, check status of
“abandon or adopt…”
Discussion about new topics for PIPs among CCO’s:
Diabetes and Oral Health
o Using gap lists to provide to both dental and PCP
providers
o Using data in Prometheus
Diabetes Controlled HBA1C:
o Self-management program
o Glucose monitoring support
Initiation and Engagement: (HealthShare, AllCare)
o Creating logic models
o Community work groups
o LEAN trainings for providers
Pgs: 76-83
OHA contact info: lisa.t.bui@state.or.us 5
o Kaiser 4 day event with Advanced Health
o Behavioral Health, SUD and PCP community
collaboratives
o Mediated Assisted Treatment focused
o Identifying levels of engagement (low, medium, high)
Assess barriers to scripts
o Creating task force
o Reduce alcohol abuse
o Site visits and provider education
SDOH
o Housing assistance focused (UNITUS)
o ORPRN and AHC
o Collaboration with Early Learning Hub and Service Int,
Team
o HRS Funds
o Closed loop referrals
Immunizations
o Promote VFC clinic certifications
New Items on the
floor n/a
n/a
Adjourn
Everyone is welcome to the meetings. For questions about accessibility or to request an accommodation, please call 971-
304-6236 or write OHA.qualityquestions@dhsoha.state.or.us. Requests should be made at least 48 hours prior to the event.
Documents can be provided upon request in an alternate format for individuals with disabilities or in a language other than
English for people with limited English skills. To request a document in another format or language, please call 971-304-
6236 or write OHA.qualityquestions@dhsoha.state.or.us.
New 2020 Medicaid Quality Incentive MetricsReview and Workflow IdeasCentral Oregon
Today’s Agenda
Change to postpartum metric specifications
New 2020 QIMS – Workflows and Impact
• Well Child Checks 3-6 year old
• Adolescent Immunizations
• Preventive Dental (1-5 year olds and 6-14 year olds)
• Initiation and Engagement of Alcohol and Other Drug Abuse or
Dependence Treatment (IET)
Your PacificSource Quality, Risk Adjustment,
Population Health and Pharmacy Team
• Andrea Ketelhut, Quality Incentive Measure Program Manager
• Chelsea Hammers, Population Health Manager
• Tanya Nason, Traditional Health Worker Liaison
• Sabrina Stuart, Risk Adjustment Coding Manager
• Therese McIntyre, Population Health Strategist
• Ryan Daven, Behavioral Health Population Health Manager
• Tim Hughes, Director of Risk Assessment
• Annie Gottfried, Quality Performance Coach
2020 Medicaid Quality Incentive Metrics
2020 OHA Measure Set
https://www.oregon.gov/oha/HPA/ANALYTICS/C
COMetrics/2020-CCO-incentive-measures.pdf
Preventive Measures:
• Well child checks
• Adolescent immunizations (HPV)
may be a challenge
Behavioral Health
• Remains a strong focus
• One new measure
Oral Health
• One new measure
• Stronger member education
* notates new measures
• Postpartum Metric Specification Change
• Well Child Checks 3-6 year old
• Adolescent Immunizations
• Preventative Dental (1-5 year olds and 6-14 year olds)
• Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET)
Review of New Measure Specifications
• OHA Transformation Center – Transformationcenter.org
• American Academy of Pediatrics – AAP.org
• Boost Oregon – BoostOregon.org
• You call the shots - cdc.gov/vaccines/ed/youcalltheshots.html
• Immunization Quality Improvement for Providers Program –IQIP
• American Dental Association – MouthHealthy.org
• SAMHSA - Substance Abuse and Mental Health Services –SAMHSA.gov
• New PacificSource DCO FAQ coming soon!
General Resources
Postpartum visit to an OB/GYN or other prenatal care practitioner, or
PCP on or between 7 and 84 days after delivery (was 21-56 days)
Documentation in the medical record must include a note indicating the
date when a postpartum visit occurred and one of the following:
Pelvic exam
Evaluation of weight, BP, breasts and abdomen
• Notation of “breastfeeding” is acceptable for the “evaluation of breasts” component
Notation of postpartum care, including, but not limited to:
• Notation of “postpartum care,” “PP care,” “PP check,” “6-week check.”
• A preprinted “Postpartum Care” form in which information was documented during
the visit
Perineal or cesarean incision/wound check.
Screening for depression, anxiety, tobacco use, substance use disorder, or
preexisting mental health disorders
Glucose screening for women with gestational diabetes
Documentation of any of the following topics:
• Infant care or breastfeeding.
• Resumption of intercourse, birth spacing or family planning
• Sleep/fatigue.
• Resumption of physical activity and attainment of healthy weight
Postpartum Metric Changes
Well Child Visits for 3-6 year olds
• General Description: The percentage of members 3-6
years of age who had one or more well-child visits with a
PCP during the measurement year.
• Numerator: At least one well-child visit (well-care value
set) with a PCP during the measurement year not DOB.
• Denominator: Eligible population as of December 31 of
measurement year
• Gap Closure: Claims based (well-care value set)
• Continuous enrollment: The measurement year
• Allowable gap: No more than one gap of up to 45 days
Well Child Visits for 3-6 year olds – Workflow ideas
Early identification utilizing EHR
population health tools
EHR recalls for this population
Utilize NCQA coding tips to actively reflect
care rendered
Never miss an opportunity to perform a
Well-Child exam. Well-Child exams can be
performed during sick visits if appropriate
Well Child Visits for 3-6 year olds – Workflow ideas cont.
Educate staff to schedule visits within the guideline time frame
Visits to school-based clinics with practitioners whom the organization would consider PCPs may be counted if documentation of a Well-Child exam is available in the medical record
Refer to the American Academy of Pediatrics Guidelines for Health Supervision and Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents for more information
Well Child Visits for 3-6 year olds – Coding
Source Codes Visit Type
CPT 99381-99385,99391-99395,
99461
Well-Care
ICD-10 Z00.121 Encounter for routine child
health check with abnormal
findings
ICD-10 Z00.129 Encounter for routine child
health check without abnormal
findings
ICD-10 Z00.8 Encounter for other general
examination
Well Child Visits for 3-6 year olds - Baseline
Central Oregon
CCO NUM DEN RATE 2020 Benchmark
Estimated
Target
Central Oregon 2576 3652 70.5 78.5 73.5
Immunizations for Adolescents (IMA)
• General Description: The percentage of adolescents 13 years of
age who had one dose of meningococcal vaccine, one dose of
Tdap vaccine and have completed the HPV vaccine series by
their 13th birthday
• Numerator: Received all three vaccinations with a date of service
on or between the child’s 9th and 13th birthday
Meningococcal: 11th-13th birthday
Tdap: 10th-13th birthday
HPV: 9th -13th birthday
• Denominator: Eligible population as of the member’s 13th
birthday
• Gap Closure: Claims based (vaccination CPT codes) and Alert
Data
• Continuous enrollment: 12 months prior to the member’s 13th
birthday
• Allowable gap: No more than one gap of up to 45 days
Immunizations for Adolescents (IMA)
• Potential Workflow Changes/Impacts Early identification utilizing EHR population health tools of children turning 9
early in 2020
Set EHR recalls for this population based on AWCVs
Potential identification based on missing immunization
Additional parent education of the value of the yearly physical/check-up and the value of the immunizations
HPV – cancer prevention, vaccine will not cause promiscuity
Meningococcal vaccine - important for the pre-teen years as they are at higher risk in this age group – they share everything with their friends!)
Consider a community event - provide AWCV, immunizations, and complete sports forms
Immunizations for Adolescents (IMA)
• Potential Workflow Changes/Impacts
Utilize NCQA coding tips to actively reflect care rendered
Educate staff on vaccine hesitancy and develop talking points
Outreach parents to schedule their child’s vaccination appointments
Administer vaccinations during already scheduled appointments
Educate parents on vaccinations, their side effects and perceived links
to autism
Provide educational materials on the diseases the vaccines prevent
Immunizations for Adolescents (IMA) - Baseline
Central Oregon
CCO NUM DEN RATE 2020 Benchmark Estimated Target
Central Oregon 557 1946 28.6 40.4 31.6
Preventative Dental – 1-5 and 6-14 years old
• General Description: The percentage of members 1-14 years of age who had at
least one dental visit during the measurement year.
• Numerator: One or more dental visits with a dental practitioner during the
measurement year. Any visit with a dental practitioner during the measurement
year meets criteria.
• Denominator: The eligible population
• Gap Closure: Claims based
• Continuous enrollment: The measurement year
• Allowable gap: No more than one gap of up to 45 days
• Ages: 1-14 years as of December 31 of the measurement year
Preventative Dental – 1 - 5 and 6 - 14 year olds – Why it’s important
• About 1 of 5 (20%) children aged 5 to 11 years have at least one untreated decayed tooth.1
• 1 of 7 (13%) adolescents aged 12 to 19 years have at least one untreated decayed tooth.1
• Children aged 5 to 19 years from low-income families are twice as likely (25%) to have cavities, compared with children from higher-income households (11%).1
Preventative Dental – 1-5 and 6-14 year olds
• Potential Workflow
Changes/Impacts Care coordination
Refer patients to dentists and track
Routine parent/child education during visits – Does your child have a regular dentist? Have they been seen this year?
Consider tele-dentistry
Provide educational information to patients
Preventative Dental – 1-5 and 6-14 year olds-Baseline
Central Oregon
Age group NUM DEN RATE
2020
Benchmark Estimated Target
1-5 2750 6017 45.7 46.3 46.3
6-14 5709 9238 61.8 68.8 68.8
Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET)
• General Description: The percentage of adolescents and adult members with a new episode of alcohol or
other drug (AOD) abuse or dependence who received the following:
Initiation of AOD Treatment. The percentage of members who initiate treatment through an inpatient
AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization, telehealth or
medication treatment within 14 days of the diagnosis
Engagement of AOD Treatment. The percentage of members who initiated treatment and who had
two or more additional AOD services or medication treatment within 34 days of the initiation visit
• Numerator:
If the index episode was an inpatient discharge, the inpatient stay is considered initiation of treatment
and the member is compliant
If the index episode was not an inpatient discharge, the member must initiate treatment on the index
episode start date (IESD) or in the 13 days after the IESD
Claims based measure
• Denominator: Eligible population
Central Oregon PopulationIET Metric Baseline Data – 2019
Substance
Use
Disorder
Total Newly
Diagnosed
Number
Initiated
Treatment
Number
Engaged
Treatment
Rate
Initiated
Treatment
Rate
Engaged
Treatment
Estimated
Initiated
Target
Estimated
Engagement
Target
All SUD
Types
1826 785 350 43.1% 19.2% 46.0% 18.5%
Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET)
• Potential Workflow Changes/Impacts
Schedule the initial AOD treatment within 14 days of diagnosis
Arrange two additional visits within 34 days after the initial
treatment visit
Refer and track patient’s progress
Provide strong follow-up workflows and procedures
Provide robust care coordination
Utilize PreManage
Expand telehealth offerings (a phone call can count for both initiation
and engagement)
Increase Medication Assisted Treatment (MAT) capacity
Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET)
• Potential Workflow Changes/Impacts
Conduct screening/initiate MAT at the index appointment, when
recommended by a provider
Use Motivational Interviewing to engage patients in treatment
Provide or link patients to peer support
Train staff on brief intervention and availability of local
resources/supports for AOD
Screen for and where possible mitigate SDoH
Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET) – Coding
Guide in your packet today
Questions
Oregon ECHO Network Prioritized List of Topics
Directions: Please rank your organization’s top 10 choices, with 1 indicating the top choice and 10 indicating the lowest choice. Your organization’s name: __________________________________________________________________
Date: ______________________________________________
___ Adult Psychiatry
___ Antimicrobial Stewardship in Hospital Care (new)
___ Child Psychiatry
___ Community Health Worker (new)
___ Coordinating Whole Care of Foster Children (new)
___ Dementia 360
___ Dermatology in Primary Care (new)
___ Geriatric Behavioral Health in an Age-friendly Health System
___ Hepatitis C and Liver Care
___ Infectious Disease Prevention: Connecting Primary Care & Public Health (new)
___ Integrated Behavioral Health for Pediatric Populations
___ LGBTQ (new)
___ Pain Management and Substance Use Disorders Dental
___ Parkinson’s Disease
Oregon ECHO Network Prioritized List of Topics
___ Perinatal Health (new)
___ Prison Peer Education Project (new)
___ Rheumatology (new)
___ Team-based Care for Diabetes Management
___Trauma Informed Primary Care (new)
Write in ECHO topic(s): __________________________________________________________________
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